Why artificial intelligence in medicine cannot replace clinical intuition

Source Domain: kevinmd.com

It was a cold January night, around two in the morning on my third consecutive 34-hour shift as a senior pediatric resident at a major freestanding children’s hospital in the northeast. My floor had absorbed four admissions in the last hour, our eleventh of the night. The last was a teenage boy, new onset type 1 diabetes presenting in diabetic ketoacidosis. By the time the call came through from the emergency department, his labs were trending in the right direction. His anion gap had closed. He met floor criteria. On paper, he was improving. My intern was buried in paperwork, so I went down to the emergency department to do the assessment myself. I pulled back the curtain.

He was awake but sleepy. He could tell me his name, the date, and where he was. In the chart this gets documented as “alert and oriented times three.” But his eyes were glazed in a way that had nothing to do with the hour. There was a slight slur to his speech, barely perceptible. And a stillness that did not fit the clinical picture I had been told over the phone. Something was wrong. I did not have a number or word for it. I just knew.

The pediatric intensive care unit fellow and emergency department attending pushed back. Of course he looks tired, he has been sitting here for hours. They were not wrong. That just was not the right answer. I stood my ground. I cited what I could, the speed of correction, the risk of cerebral edema, but what I had felt in the moment of pulling back that curtain was something prior to language. Something that lived upstream of the chart.

Lost in translation

Every time a physician walks out of a patient’s room, something gets lost. The encounter has to be translated. Think of a song that has followed you through your life. Hear it unexpectedly in a grocery store and something happens before you have processed a single lyric, your body responds, a feeling arrives, a memory surfaces with eerie fidelity. Now read those lyrics on a page. It is not…

Source